Study designs of evaluations included in the review
RCTs and systematic reviews published in or after 2004 were eligible. None of the included studies was a parallel trial.
Specific interventions included in the review
Studies comparing the inhalation of ciclesonide with that of budesonide, beclomethasone or fluticasone were eligible for inclusion. Studies on oral, nasal or intravenous administration were excluded, as were studies that compared ciclesonide treatment with placebo only or asthma treatments other than the mentioned comparators. The included studies compared the administration of ciclesonide (400 microg once daily or 800 microg once or twice daily) with the administration of budesonide (400 or 800 microg daily; given in a turbohaler), or fluticasone (250 or 1000 microg once or twice daily). None of the included studies compared ciclesonide with beclomethasone.
Participants included in the review
Studies including adults (18 years and over) with a diagnosis of chronic asthma were eligible. Patients with acute asthma, chronic obstructive pulmonary disease or allergic rhinitis were excluded. The patients in the included studies had a mean age of 33 to 47 years, not all studies were in non-smoker samples only, and more than half of the studies involved participants with mild asthma (forced expiratory volume in 1 second less than 90% of predicted value).
Outcomes assessed in the review
The review considered all reported outcomes with an emphasis on patient outcomes. The included studies assessed lung function tests (e.g. FEV1, FVC, PEF), symptoms (diary and use of rescue medication), quality of life (Mini Asthma Quality of Life questionnaire), airway responsiveness to provoking agents (adenosine monophosphate or metacholine until a 20% reduction in FEV1 is reached), inflammatory markers (nitric oxide exhaled, inflammatory markers in sputum), hypothalamic-pituitary-adrenal suppression (plasma cortisol response to human corticotrophin-releasing factor, urine cortisone) and oropharyngeal deposition. The duration of the study, which also determined the follow-up measurement, ranged from measurements up to 60 minutes after the intervention to a maximum of 4 weeks.
How were decisions on the relevance of primary studies made?
Two reviewers independently screened the studies. Any disagreements were resolved through discussion.